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Driven by the obesity epidemic, the number of bariatric operations performed in the United States has increased markedly, by one estimate from ~20,000 in 1998 to 140,000 in 2004, and plateaued thereafter [1]. While diarrhea is a recognized consequence of intestinal bypass procedures, Roberson and colleagues in this issue of the journal highlight, for the first time, that fecal incontinence (FI) may begin or worsen after bariatric surgery [2]. Of note, 48% of women and 42% of men reported FI for liquid stools while 21% of women and 30% of men reported solid FI after surgery. Moreover, 55% of women and 31% of men reported their symptoms were worse after surgery. While these figures may be affected by response rates (48%) or, since surveys were only conducted after surgery, by recall bias, they draw attention for the first time to an underappreciated and significant problem since FI can be a devastating symptom which can substantially impair quality of life [3, 4].

Incontinence: An Underappreciated Problem in Obesity and Bariatric Surgery